History
A detailed history is required to diagnose the underlying cause of failure to thrive in the elderly population. All systems should be reviewed to identify new symptoms indicative of a new diagnosis or a worsening existing condition.
A detailed nutrition history to review all aspects, including food shopping, cooking, frequency of meals, and type of food groups consumed, is taken into consideration. A validated tool to assess the nutritional status in elderly persons is the Mini Nutritional Assessment.
A review of medication lists, including over-the-counter medications and herbal products, is critically important.
A social history should include documentation and quantification of alcohol and substance intake. The health provider needs to inquire about social support available from family, friends, and community, as well as barriers such as falls and balance problems leading to social isolation and need for more supervision.
An important aspect of the history is cognitive evaluation to assess dementia. Many instruments can be used for this assessment, including the Mini-Cog Test, Mini-Mental State Examination, and General Practitioner Assessment of Cognition. Dementia needs to be differentiated from pseudodementia related to depression.
Another important aspect is the functional assessment in terms of ambulation and carrying out activities of daily living (ADL). Both the Katz ADL and Lawton IADL can be used to assess the performance of ADL.
Finally, the patient is evaluated for any underlying mental health conditions such as depression or anxiety. The Geriatric Depression Scale (GDS) has been specifically designed for elderly persons. [8] Alternatively, a single screening question, “Do you often feel sad or depressed?” may effectively screen for depression. [9]
Physical Examination
A complete examination, including a vision and hearing test, is the first step to evaluate for deterioration of existing medical conditions or diagnosis of new diseases. In addition, the examination will help identify signs of malnutrition and vitamin deficiencies.
Timed Up and Go is a quick and reliable test to assess mobility. The patient is asked to get up from a chair and walk 3 meters before returning to the chair. The time taken by the patient to complete the task is used to grade the functional mobility.
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Management of failure to thrive.
